Anxiety linked to stroke risk

NEW YORK (Reuters Health) - Men and women with severe
symptoms of anxiety may have a higher risk of stroke than their
more relaxed counterparts, a new study suggests.

"The greater your anxiety level, the higher your risks
of having a stroke," study co-author Dr. Maya J. Lambiase, of
the University of Pittsburgh School of Medicine, told Reuters
Health.

"Assessment and treatment of anxiety has the potential to
not only improve overall quality of life, but may also reduce
the risk of cardiovascular diseases, such as stroke, later in
life," she said in an email.

Dr. Philip Muskin, a professor of psychiatry at Columbia
University Medical Center in New York emphasized that the stroke
risk identified in the study among overly anxious individuals
was not vastly increased.

"What it's really saying is, you're a little more likely to
have a stroke," said Muskin, who was not involved in the study.
Still, he added, "I would like to be a little less likely (to
have a stroke) in my life."

Stroke is one of the leading causes of death in the U.S.,
but few studies have looked at psychosocial factors other than
depression or psychological stress or distress, that may
contribute to a person's risk of stroke.

Yet, Lambiase and her colleagues point out, anxiety has been
linked to increased cigarette smoking, alcohol abuse and
physical inactivity - all of which are known to increase stroke
risk.

To investigate the association between anxiety and stroke,
the researchers analyzed data from 6,019 men and women who were
enrolled in the First National Health and Nutrition Examination
Survey in 1971-1975 and followed for about 16 years.

The participants were interviewed at the start of the study
to determine the presence and severity of any anxiety symptoms,
and stroke events were identified by examining hospital or
nursing home discharge reports and death certificates.

A total of 419 strokes occurred throughout the study period,
but the risk of stroke was higher among those who reported
greater anxiety symptoms, including excessive feelings of worry,
stress and nervousness, at the initial interview.

Overall, anxiety was linked to a 14 percent higher risk of
stroke relative to participants who were not anxious, Lambiase
and her co-authors report in the American Heart Association
journal Stroke.

But stroke risk also appeared to rise in line with
increasing severity of anxiety symptoms, the results suggest.

The link between anxiety and stroke risk remained even after
the researchers took into consideration other factors that may
have influenced cardiovascular health, such as alcohol use,
physical activity and smoking. After those adjustments, men and
women with higher levels of anxiety were 33 percent more likely
to experience stroke than those with fewer anxiety symptoms.

Similarly, the link between anxiety symptoms and increased
stroke risk remained when the researchers accounted for study
participants' age, gender and symptoms of depression.

The researchers didn't analyze the reason for the connection
between anxiety and stroke, but they speculate multiple factors
are likely to be involved. These could include unhealthy coping
behaviors people with anxiety indulge in as well as
overactivation of the sympathetic nervous system, which controls
fight-or-flight responses, such as the release of stress
hormones.

"People with high anxiety levels are more likely to smoke
and be physically inactive, possibly explaining part of the
anxiety-stroke link," Lambiase said. "Higher stress hormones,
blood pressure or sympathetic output may also be factors."

"However," she added, "future research is needed to
determine the precise mechanisms whereby greater levels of
anxiety increase a person's risk for stroke."

Dr. Muskin acknowledged that the study findings do point to
a greater risk of stroke among overly anxious people, "but there
are things you can do about that," he said.

Noting that "anxiety predicts bad health behaviors," Dr.
Muskin cited the importance of stopping smoking and starting to
exercise. He also described the importance of meditation and
proper breathing techniques, which he teaches in his private
practice with patients.

"Doing nothing leaves you at a higher risk (of stroke)," he
said, but breathing exercises have "a psychologically beneficial
effect," with no harm and no addicting qualities, he told
Reuters Health.